Pacific Journal of Medical Sciences, Vol. 13, No.

2, Dec 2014

ISSN: 2072 1625

PACIFIC JOURNAL OF MEDICAL SCIENCES

{Formerly: Medical Sciences Bulletin}

ISSN: 2072 1625

Pac. J. Med. Sci. (PJMS)

www.pacjmedsci.com. Email: pacjmedsci@gmail.com.

A CASE REPORT
DENTURE INDUCED INFLAMMATORY HYPERPLASIA A CASE REPORT
Anjana Mohan Kumar, *Veena KM, Laxmikanth Chatra, Prashanth Shenai, Prasanna Kumar Rao,
Rachana V Prabhu, Tashika Kushraj and Prathima Shetty
Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University,
Mangalore, Karnataka, India
*Correspondence author: veenaomr@rediffmail.com
Running Title: Epulis fissuratum

Pacific Journal of Medical Sciences, Vol. 13, No. 2, Dec 2014

ISSN: 2072 1625

A CASE REPORT
DENTURE INDUCED INFLAMMATORY HYPERPLASIA A CASE REPORT
Anjana Mohan Kumar, *Veena KM, Laxmikanth Chatra, Prashanth Shenai, Prasanna Kumar Rao,
Rachana V Prabhu, Tashika Kushraj and Prathima Shetty
Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University,
Mangalore, Karnataka, India
*Correspondence author: veenaomr@rediffmail.com
Running Title: Epulis fissuratum
ABSTRACT:
Epulis fissuratum is a benign tumor like inflammatory hyperplastic growth which occurs on the mucosa
along the borders of an ill fitting full or partial removable denture. If ulcerated, it can mimic oral
squamous cell carcinoma. The treatment includes surgical removal of excess fibrous tissue and
remodelling or reconstructing the denture suitably, ensuring better adaptability to the ridges. This case
report describes a 55 year old male patient with characteristic clinical features of denture induced
inflammatory hyperplasia.
Key words: Epulis fissuratum, ill fitting denture, inflammatory hyperplasia
Submitted May 2014; Accepted August 2014

INTRODUCTION:

the denture flange conveniently fits and is often

One of the most common tissue reactions to a

asymptomatic unless ulcerations occur in the

chronically ill fitting denture is the occurrence of

base of the fold. Epulis fissuratum (EF) can be

hyperplasia of tissue along the denture borders

treated conservatively or surgically based on

[1]. This proliferation may be the result of

the size of the lesion [2].

resorption of alveolar ridge, leading to over

extension of the denture borders causing

CASE REPORT:

chronic irritation to the oral mucosa in the

A 55 year old, male patient reported to the

sulcus

slow

outpatient department [OPD] with a complaint

development of elongated rolls of tissue in the

of missing tooth in the maxillary front region

mucolabial or mucobuccal fold area into which

and desired replacement. The upper right

area.

Characterised

by

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Pacific Journal of Medical Sciences, Vol. 13, No. 2, Dec 2014

ISSN: 2072 1625

central incisor was mobile and fell off by itself

having grade 1 mobility. A sessile exophytic

two months back. He is a partial denture

growth was also seen on the labial mucosa of

wearer on upper arch and complete denture on

the mandibular arch in the anterior region and

lower arch since 5 years. Intra oral examination

extending symmetrically on either side of the

showed completely edentulous lower arch and

midline [Figure 1a]. The tissue was split

partially edentulous upper arch with only two

longitudinally all along its length forming two

teeth remaining, maxillary right lateral incisor

folds and the denture fitted comfortably in

and maxillary left central incisor, which were

between the folds [Figure 1b].

Figure 1: A: Exophytic growth in the mandibular anterior region with two folds and a
solitary ulcer in the centre. B: The lesion comfortably fits in between the two folds.

Figure 2:- A- Immediately After surgical excision. B- After 7 days

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Pacific Journal of Medical Sciences, Vol. 13, No. 2, Dec 2014

ISSN: 2072 1625

The superficial fold towards the labial mucosa

The lesion has a strong female predilection and

was smaller measuring 1.5 x 0.5 cm and the

is seen in age group of 30-60 years, with a

fold towards the alveolar ridge was larger

peak incidence in the sixth decade [5]. Majority

measuring 2.5 x 1.5 cm in size. The surface of

of lesions are seen in the maxilla than in

the tissue was smooth and the colour and

mandible. Anterior portion of jaws is affected

texture was same as that of the surrounding

more often than posterior area. The strong

mucosa. In the centre of the two folds was a

female predilection is thought to be due to

solitary ulcer about 1.0mm in diameter. The

various factors like more women are denture

patient was not aware of the growth or the

wearers than men due to cosmetic reasons,

ulcer. On palpation the tissue was firm and non

they have a longer life span than men and

tender. On the basis of history and clinical

hormonal deficiencies can enhance formation

examination a provisional diagnosis of denture

of epulis especially after menopause [6]. It is

induced inflammatory fibrous hyperplasia/ EF

seen more in the maxilla than the mandible

was made. The patient was instructed to

because the area of mucosa covered by a

discontinue the use of the denture. As the ulcer

denture is greater in the maxilla than the

was a healing one no treatment was

mandible so the pressure being inserted to the

suggested. The patient underwent extraction of

underlying mucosa is higher in maxilla. There

the two teeth and excision of the exophytic

are some contradictory results, such as those

tissue [Figure 2a and 2b] and fabrication of new

in the De Baat et al. [5] study that shows that

dentures. The excised tissue was sent for

the lesions are more in the mandible than the

histopathologic examination.

maxilla.
In the present case the EF is seen in a male

DISCUSSION:

patient in the same age group as mentioned

The term epulis, first described by Virchoff, has

above and in the mandibular anterior region.

its origin in Greek language (epi on; oulon gum)

The lesions may be single or numerous

describing something appearing on the gingival

composed of flaps of hyper plastic tissue.

gumline [2]. EF is a common sequela of

Presence of inflammation is variable and if

wearing ill fitting dentures, characterized by

present is seen in the bottom of deep fissures.

hyperplasia of the mucosa due to contact with

In some cases ulceration may occur. Diagnosis

denture border [3]. Other names used to

can be made based on the history and clinical

describe the lesions are - Denture induced

examination of the patient. However after

inflammatory fibrous hyperplasia, redundant

surgical excision histopathological examination

tissue, denture injury tumor, denture epulis [4].

is mandatory to yield a confirmatory diagnosis

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Pacific Journal of Medical Sciences, Vol. 13, No. 2, Dec 2014

ISSN: 2072 1625

as there are many lesions that may appear in

interspersed with fibroblasts and blood vessels.

the area which can have a more serious

Here the distinction between hyperplasia and

outcome [7].

neoplasia may not be very clear cut in all the

Histopathologic feature of epulis fissuratum

cases.

include excessive bulk of fibrous connective

Peripheral giant cell granuloma/epulis is a

tissue covered by a layer of stratified squamous

reactive lesion seen more commonly in females

epithelium [7]. Connective tissue is composed

in the fourth to sixth decade of life occurring in

of bundles of collagen fibres, with few

the mandibular gingiva or alveolar process

fibroblasts or blood vessels unless there an

anterior to molars as a sessile or pedunculated

active inflammatory reaction is present. Lesions

mass [9]. Surface has a dark red or vascular

with almost similar clinical features are

appearance and ulcerations may be seen.

pyogenic granulomas, fibromas, peripheral

Histologic appearance is characteristic here,

giant cell granulomas, peripheral ossifying

with presence of multinucleated giant cells. In

fibroma, neurofibroma, oral squamous cell

edentulous patients peripheral giant cell

carcinoma [4]. Pyogenic granulomas are

granuloma can cause superficial erosion of

purple-red nodular inflammatory hyperplastic

bone seen as peripheral cuffing in a

lesion usually pedunculated, again seen more

radiograph.

commonly in females, on the maxillary anterior

Peripheral ossifying fibroma are focal gingival

region especially on the gingiva due to chronic

over growths seen anterior to the molars, in

irritation [8] It bleeds on slightest provocation,

young females [10]. The surface of the lesion

but is painless unless ulcerated and has a rapid

smooth and is of the same colour as

growth pattern unlike epulis fissuratum and is

surrounding mucosa. Characteristic feature

not associated with denture wearing and also

seen in the histopathologic examination is the

histologic picture shows granulation tissue.

presence of multiple calcifications, which is the

Fibromas are common benign soft tissue

differentiating feature of the lesion.

neoplasms more commonly seen in the buccal

Neurofibroma is a benign neoplasm of nerve

mucosa in the line of occlusion, though can be

tissue origin. Oral lesions are rare, but when

seen on other sites also including gingival [7].

present, are seen to occur on the buccal

They appear as elevated nodules of normal

mucosa, palate, alveolar ridge, vestibule and

colour with a smooth surface and a sessile or

tongue, as discrete non ulcerated nodules

occasionally pedunculated base. It is a slow

having same colour as the surrounding mucoa

growing lesion more common in females seen

[11]. Histologic features of neurofibroma are

in the third, fourth and fifth decades. Histologic

considered to be virtually diagnostic with

features include bundles of collagen fibers

myxomatous peripheral nerve tissue within the

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Pacific Journal of Medical Sciences, Vol. 13, No. 2, Dec 2014

perineural sheath scattered within a collagen
rich matrix. Oral squamous cell carcinoma is
the most common malignant neoplasm of the

ISSN: 2072 1625

REFERENCES:
1.

oral cavity occurring at any intra oral site [12]. It

can be seen as rapidly growing mass with
ulcerations and indurations of the margins,

2.

affecting men more commonly than women.

Based on histologic findings it can be well

3.

differentiated, moderately differentiated and

poorly

differentiated.

conservative

or

Treatment

surgical

includes

4.

management

depending on the duration and size of the

5.

lesion [13]. Conservative management includes

repairing the denture, relining it or fabricating a

6.

new denture if it is ill fitting. And surgical

managements include the use of surgical

7.

scalpel, the electro surgery or laser techniques

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dioxide

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8.

[2].Prognosis is usually good as long as the

causative factor is removed successfully.
9.

CONCLUSION:
Epulis fissuratum is a common lesion seen in

10.

elderly people associated with chronic trauma

due to ill fitting dentures. Hence care should be

11.

taken while fabricating dentures and frequent

review should be done to check for ridge

12.

resorption. Proper hygiene of the denture

should be maintained by the patient. Surgical
excision

and

biopsy

of

the

tissue

is

recommended to rule out the other pathologies

13.

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